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October 12, 2009

Proactive, Personalized Telephone Counseling Can Help Teen Smokers To Quit

by Sam Savage

Personalized, proactive telephone counseling centered on motivational interviewing and cognitive behavioral skills training has been found to favorably impact quit rates among teen smokers, according to a pair of studies published online October 12 in the Journal of the National Cancer Institute.

Arthur V. Peterson, Ph.D., and colleagues at Fred Hutchinson Cancer Research Center in Seattle, and colleagues designed the Hutchinson Study of High School Smoking trial to evaluate to what extent telephone counseling could help teenagers quit smoking. The researchers proactively identified more than 2,000 smokers via classroom surveys of juniors in 50 high schools in Washington state. In 25 of the high schools, after parental approval teen smokers received personalized smoking cessation counseling that combined motivational interviewing and cognitive behavioral skills training. These included using the smoker's own words and values to increase importance of quitting, anticipating and coping with stress and other triggers to smoke, and making plans for stopping. The study also included more than 700 nonsmokers to ensure that contacting students for participation in the trial would not reveal a participant's smoking status.

More than a year after the intervention began, nearly 89% of the students completed a follow-up survey in which 22% of intervened smokers reported 6-month prolonged abstinence from smoking, compared to 18% among students in the no-intervention control arm. There was also strong evidence that the intervention had made a difference for 3-month, 1-month, and 7-day abstinence and for the length of time since last cigarette.

An accompanying paper by Kathleen Kealey, also from the Hutchinson Center's Cancer Prevention Program, Division of Public Health Sciences, and colleagues describes the design of the counseling intervention used to attain these results, as well as its implementation and assessments of counseling fidelity and adherence to protocol.

This is the first adolescent smoking cessation trial to report a statistically significant intervention impact on 6-month prolonged abstinence, as measured one year post-intervention, in a large, general population of teens.

"The results of the [Hutchinson Study] trial show that proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach," the authors write, "and that delivery of a proactive, personalized counseling intervention via the telephone by well-trained counselors can be effective in increasing teen smoking cessation."

In an accompanying editorial, Scott J. Leischow, Ph.D., of Arizona Cancer Center, The University of Arizona in Tucson, and Eva Matthews, MPH, of the Department of Family and Community Medicine at the University of Arizona, laud the studies: it's remarkable for its results, but it also shows how theory driven and methodologically sound behavioral research can be, they write. The editorialists credit the researchers' success to good relationships with the school system and a rigorous implementation strategy tailored to each student.

"[W]hen a game-changing study provides new hope for how tobacco-using youth can be treated, the collective 'ears' of the public health community should perk to attention," the editorialists write. "The report by Peterson et al. in this issue, along with its accompanying methodologic piece by Kealey et al. is such a study."